Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report
Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.
Figure 1. Panorama XP obtained at the time of dental implant removal shows no obvious abnormal findings around the dental implant fixtures. Figure 2. The intraoral view from the first visit shows widespread exposed necrotic bone in the right mandible (a and b). Figure 3. Panorama XP obtained at the first visit reveals that the removal sockets of 3 implant fixtures remain and extensive sclerosis is recognized around the sockets in the right mandible (white arrowhead).
Figure 4. (a) Computerized tomography shows some sequestra located in the sockets and increased bone marrow density spreading from the midline to the third molar area of the right mandible. (b) T1-weighted magnetic resonance imaging (MRI) shows low intensity in the right mandibular bone marrow. (c) T2-weighted MRI shows moderately high intensity in the right mandibular bone marrow. (d) Bone scintigraphy shows a focus of increased radiotracer uptake in the right mandible. Figure 5. An intraoperative view of the sequestrectomy. (a) After flap elevation, (b) bone sequestra around the implant removal cavities were eliminated with a steel bur.
Figure 6 . (a) Surgical specimen of the necrotic bone. (b) The bone is nonvital and the osteocyte lacunae are empty. (c and d) Colonies of Actinomyces sp. adhere to the surface of the bone. Figure 7. (a) Intraoral view 7 months postoperatively reveals that there was no recurrence in the right mandible. (b) Panorama XP obtained 7 months postoperatively reveals that the affected bone has been resected and there is no recurrence in the right mandible. HE indicates hematoxylin and eosin.
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